Targeted delivery of galunisertib attenuates fibrogenesis in an integrated ex vivo renal transplant and fibrosis model

Abstract Normothermic machine perfusion is an emerging preservation technique for kidney allografts to reduce post-transplant complications, including interstitial fibrosis and tubular atrophy. This technique, however, could be improved by adding antifibrotic molecules to perfusion solutions. We established Machine perfusion and Organ slices as a Platform for Ex vivo Drug delivery (MOPED), to explore fibrogenesis suppression strategies. We perfused porcine kidneys ex vivo with galunisertib—a potent inhibitor of the transforming growth factor beta signaling pathway. To determine whether effects persisted, we also cultured precision-cut tissue slices prepared from the respective kidneys. Galunisertib supplementation improved the general viability, without negatively affecting renal function or elevating levels of injury markers or byproducts of oxidative stress. Galunisertib also reduced inflammation and more importantly, strongly suppressed the onset of fibrosis, especially when the treatment was continued in slices. Our results illustrate the value of targeted drug delivery, using isolated organ perfusion, for reducing post-transplant complications. One Sentence SummaryGalunisertib supplementation during normothermic machine perfusion attenuates fibrogenesis without compromising renal function.